Author: Nanadadzie Ghansah

“No amount of money can reward the work and sacrifice of policemen, teachers and nurses. Their reward is in Heaven!”
– the late Michael Ghansah

I make the effort to see my patients before they are rolled back for surgery. I can easily say that 3 out of 4 times, when I walk up to the patients, the assembled family members assume I am an orderly who is taking the patient back to surgery. When I introduce myself as the anesthesiologist, the surprise or disappointment is always palpable.
Am I bothered by the reaction? Sure, who wouldn’t be in my situation. One just learns to live with it. The bigger question though is: what drives such an assumption?
Walk through most US hospitals. Most of the doctors are white, the janitors and orderlies are black. The doctors are male, the nurses are women. So implicitly, most people see a black guy and subconsciously think “Orderly”. I know several female colleagues who are addressed as “Nurse”!
It is not the fact that one feels demoted by being seen as an orderly or a nurse. No! It is the implicit bias inherent in the assumption that is bothersome.

Implicit bias!
“….implicit stereotypes and implicit attitudes that are shaped by both history and cultural influences. Implicit biases encompass the myriad fears, feelings, perceptions, and stereotypes that lie deep within the subconscious; they act on those memory records and exist without an individual’s permission or acknowledgement. In fact, implicit bias can be completely contradictory to an individual’s stated beliefs—a form of conscious-unconscious divergence.”

Compared to explicit bias, implicit bias is unconscious. So you may think all women who work in the hospital are nurses even though you do not realize it. An example of explicit bias is known and accepted prejudice or even hatred for a race or people – racism!.

With patients not really being in a position of power relative to me, their biases do not significantly impact my day. The situation is quite different when the roles are reversed. Where the one with the bias is in the position of power. Say the physician one sees in the ER or a sentencing judge or a cop with a gun.
In a 2012 study looking at how pediatricians treated their patients with pain, white patients were more likely to get pain medicine prescribed for pain than black ones.
Researchers found that when controlling for numerous factors like severity of the primary offense, number of prior offenses, use of force etc, individuals with the most prominent Afrocentric features received longer sentences than their less Afrocentrically featured counterparts. So if you had dark skin, a wide nose, and full lips, you were toast!
Racial bias in policing has been in the news lately. Events like the killing of Michael Brown in Ferguson, MO or Tamir Rice in Cleveland have thrust the issue into the news. The killing of Alton Sterling yesterday in Baton Rouge and Philando Castille in Minnesota today have escalated the tensions. Movements like Black Lives Matter, All Lives Matter and Blue Lives Matter have all arisen to defend different parts of the debate.

One thing is for sure though. Implicit bias plays a huge role in law enforcement and the broader judicial system in this country.
Cops intervene disproportionately with blacks and Hispanics. They are arrested or ticketed, searched, stopped or even surveilled more. Blacks are also apt to have force used against them more. One reason is that there could be more crime among minority groups. The other reason is police bias and prejudice. Implicit bias.

In 1999, a 23-year-old Guinean immigrant, Amado Diallo, was mistaken for a wanted serial rapist and shot by four New York City plainclothes cops. 41 shots were fired. 19 hit him. He died. The cops were indicted, tried and exonerated.
Shortly thereafter, researchers in Chicago and Denver started looking at the issue of implicit bias in the way white cops treated black suspects. They recruited subjects from the community as well as cops. They were shown scenarios where they had to decide to “Shoot” or “Don’t Shoot”. The scenarios contained armed and unarmed whites and blacks.
The subjects who were white ,were more apt to shoot an armed male more quickly if he was black than if he was white. However, they were quicker NOT to shoot an Unarmed White than a Black. Which means, they would shoot an Unarmed Black but not an armed White.
Researchers also found a more pronounced neurophysiological threat response when subjects were faced with a Black suspect and that this correlated with how fast they pressed “Shoot”.
A later study in Denver found that compared to people from the community, cops were less prone to have this bias – that of shooting an Unarmed Black over an Armed White. They attributed this to high quality use-of-force training that several police departments had instituted.
Interestingly, a recent study in Spokane showed that in some cases, cops may use less force against blacks – possibly putting the cop in danger – due to the media and legal backlash.

The good news is that in medicine as well as in Law Enforcement and the Judicial systems, the issue of implicit bias is now recognized and several psychologists are doing some great work in developing training programs to reduce this. The bad news is that progress is slow.
Can implicit bias be totally eradicated? I do not think so then after all we are human and having prejudices is as old as the human race itself. It surely does not excuse the killing of unarmed suspects but it helps to pinpoint where changes can be made.
Often the debate about Policing and Race is split along color lines with most minorities cognizant of a problem and most Whites thinking there is none. Well to my white friends who think there is no problem, I have news for you – THERE IS A PROBLEM!
One should appreciate the work cops do – laying their lives on the line daily to protect us. It is an unenviable job in a society awash in guns. However, the issue of disproportionate use of force against black suspects is an issue that won’t go away unless addressed. It creates mistrust, loss of life and makes cops afraid to do their job because of media and legal backlash.

I’ll end with another experience. We were flying back home and made a connection in Atlanta. As we were boarding, I couldn’t help but notice the passport of the gentleman in front of me. The inscription was in Arabic. My heart started pounding. On board the plane, I looked our for him and kept an eye on him all through the flight. When he headed for the bathroom, my fear went up a thousand notches. My relief when we landed was beyond description. When I decided to write this today, the memory of my reaction came back to me. It was the memory of my own implicit bias.

Sub-SaharanAfrica (SSA) seems to be the crucible of disease. Most of our modern day epidemics seem to emanate form this area – HIV, Ebola – to mention just two that have had significant mortality.
Disease in SSA is however nothing new. The region has always had numerous infectious and vector-borne diseases.
I seek to argue that the prevalence of disease in SSA might have changed the course of it’s history.

Lets go back several hundred years to about 1490. This is the period when Columbus landed in what is now Central America and initiated the massive migration of Europeans to the New World, as it was called. Through the activities of the migrant Europeans and disease they introduced, millions of native Americans were literally wiped out.
Now, SSA was “found” around this same time period. It ultimately became a the source of manual labor for the cotton and sugar cane plantations in the so-called New World. So why didn’t SSA see the same level of migration of Europeans like the Americas saw?

One argument is that black Africans were seen as an optimal manual labor force and so their bodies were priced over their lands. Some have also argued that SSA was more densely populated than the American continent. Yet another is that the Africans mounted a much stronger resistance against the Europeans than the Native Americans.
The argument, which I tend to favor, is the role of disease and specifically malaria. Malaria, a disease to which most indigenous Africans develop some form of immunity to over time, is devastating for anyone contracting it for the first time. It killed quite a number of European settlers.This dampened any desire for an exploration of the continent. A glimpse of what could have been is seen in South African a region with a climate and disease profile much kinder to the Europeans settlers.

Malaria as a disease was known since the time of Hippocrates. In the ancient times, it was attributed to bad air. The term Malaria was coined in Florence by the historian and chancellor of Florence Leonardo Bruni in his Historia Florentina around1400:
Avuto i Fiorentini questo fortissimo castello e fornitolo di buone guardie, consigliavano fra loro medesimi fosse da fare. Erano alcuni a’ quali pareva sommamente utile e necessario a ridurre lo esercito, e massimamente essendo affaticato per la infermità e per la mala aria e per lungo e difficile campeggiare nel tempo dell’autunno e in luoghi infermi….
After the Florentines had conquered this stronghold, after putting good guardians on it they were discussing among themselves how to proceed. For some of them it appeared most useful and necessary to reduce the army, more so as it was extremely stressed by disease and mala aria (bad air)…
It was introduced into England 1740 by Horace Walpole:
“There is a horrid thing called the malaria, that comes to Rome every summer, and kills one”, and into medical literature by John MacCulloch in 1827.

So Europeans knew of malaria and found out about other diseases that killed them in droves like dengue, yellow fever and the bugs that caused dysentery. Even David Livingstone, the Explorer and Missionary, died form malaria and dysentery. The cattle that the Europeans tried to raise were also killed off.
Unlike in the America, in Australia, the Polynesian islands and part of South Africa where European diseases killed off the natives, the opposite occurred in SSA.
A true exploration of the continent started in the mid-1800s and this was shortly after quinine was discovered to be a cure for malaria. And then you saw the true face of European colonization.

For Native Americans and Africans from the sub-saharan region, the “discovery” of their respective continents by the European explorers of the 15th century has spelled nothing but misery. For most, the misery still continues.
Unlike the Native Americans, most Africans still have control of their lands, even if they are still massively exploited by richer nations and their own corrupt leaders.
Even as disease continues to be a major factor in the lives of most people in SSA, let’s not forget that malaria might have been the one thing that saved us from extermination.

Sub-SaharanAfrica (SSA) seems to be the crucible of disease. Most of our modern day epidemics seem to emanate form this area – HIV, Ebola – to mention just two that have had significant mortality.
Disease in SSA is however nothing new. The region has always had numerous infectious and vector-borne diseases.
I seek to argue that the prevalence of disease in SSA might have changed the course of it’s history.

Lets go back several hundred years to about 1490. This is the period when Columbus landed in what is now Central America and initiated the massive migration of Europeans to the New World, as it was called. Through the activities of the migrant Europeans and disease they introduced, millions of native Americans were literally wiped out.
Now, SSA was “found” around this same time period. It ultimately became a the source of manual labor for the cotton and sugar cane plantations in the so-called New World. So why didn’t SSA see the same level of migration of Europeans like the Americas saw?

One argument is that black Africans were seen as an optimal manual labor force and so their bodies were priced over their lands. Some have also argued that SSA was more densely populated than the American continent. Yet another is that the Africans mounted a much stronger resistance against the Europeans than the Native Americans.
The argument, which I tend to favor, is the role of disease and specifically malaria. Malaria, a disease to which most indigenous Africans develop some form of immunity to over time, is devastating for anyone contracting it for the first time. It killed quite a number of European settlers.This dampened any desire for an exploration of the continent. A glimpse of what could have been is seen in South African a region with a climate and disease profile much kinder to the Europeans settlers.

Malaria as a disease was known since the time of Hippocrates. In the ancient times, it was attributed to bad air. The term Malaria was coined in Florence by the historian and chancellor of Florence Leonardo Bruni in his Historia Florentina around1400:
Avuto i Fiorentini questo fortissimo castello e fornitolo di buone guardie, consigliavano fra loro medesimi fosse da fare. Erano alcuni a’ quali pareva sommamente utile e necessario a ridurre lo esercito, e massimamente essendo affaticato per la infermità e per la mala aria e per lungo e difficile campeggiare nel tempo dell’autunno e in luoghi infermi….
After the Florentines had conquered this stronghold, after putting good guardians on it they were discussing among themselves how to proceed. For some of them it appeared most useful and necessary to reduce the army, more so as it was extremely stressed by disease and mala aria (bad air)…
It was introduced into England 1740 by Horace Walpole:
“There is a horrid thing called the malaria, that comes to Rome every summer, and kills one”, and into medical literature by John MacCulloch in 1827.

So Europeans knew of malaria and found out about other diseases that killed them in droves like dengue, yellow fever and the bugs that caused dysentery. Even David Livingstone, the Explorer and Missionary, died form malaria and dysentery. The cattle that the Europeans tried to raise were also killed off.
Unlike in the America, in Australia, the Polynesian islands and part of South Africa where European diseases killed off the natives, the opposite occurred in SSA.
A true exploration of the continent started in the mid-1800s and this was shortly after quinine was discovered to be a cure for malaria. And then you saw the true face of European colonization.

For Native Americans and Africans from the sub-saharan region, the “discovery” of their respective continents by the European explorers of the 15th century has spelled nothing but misery. For most, the misery still continues.
Unlike the Native Americans, most Africans still have control of their lands, even if they are still massively exploited by richer nations and their own corrupt leaders.
Even as disease continues to be a major factor in the lives of most people in SSA, let’s not forget that malaria might have been the one thing that saved us from extermination.